Diagnostic Approach to Breast Pain in Children

Clinical Evaluation and Diagnosis

Periareolar inflammation can occur even in prepubertal children with localized pain and tenderness, according to the American College of Radiology 1
Clinical breast examination is the primary diagnostic tool in this age group, as imaging is rarely indicated for isolated breast pain without a palpable mass, as recommended by the American College of Radiology 2
Ultrasound is the first-line imaging modality if a mass is palpable or infection is suspected, as it avoids radiation exposure in children, according to the American College of Radiology 2
Mammography is not appropriate in prepubertal or early pubertal children, as stated by the American College of Radiology 2
Consider non-breast sources of pain, including chest wall conditions (costochondritis, muscle strain) that may be perceived as breast pain, as noted by the American College of Radiology 1

Reassurance is the cornerstone of management for benign developmental causes, such as premature thelarche and early puberty, which are typically benign, although this information is from Praxis Medical Insights, an alternative source is preferred but not available 3
Supportive care with NSAIDs for pain management is recommended for traumatic causes, although this information is from Praxis Medical Insights, an alternative source is preferred but not available 3